Terrebonne Parish Consolidated Government

	Applying for:	Sales Tax Hotel/Motel Occupational License *
	Type:	Urban Rural *

1.	Reason for Applying:	*

	Name of previous owner:	*
	Trade name of previous owner:	*
	Parish account number:	*

	Explain: List Companies (separated by commas):
	*

2.	LA Sales Tax Number:	*
		Applied For
		None
	Federal Identification Number:	*
		Applied For
		None
	How many other locations in the Parish:	*
	Other Business Name:
	Prior Business Name:

3.	Legal Names(s) (Individuals, partners, or corporation):
	*
	Trade name of business (everyday name):
	*


4.	Business Location address:		(Street, route or highway - NOT P.O. Box)
	*
	City:	*		State:	*	Zip:	*
	Telephone:		- - *

	Mailing Address:
5.	Address for receiving tax forms or correspondence:
	Same as business location
	*
	City:	*	State:	*	Zip:	*

6.	Contact Person:	*		Cell Phone Number:	- -
	Contact Phone Number:	- - *		Fax Number:	- -
	E-Mail Address:	*	A copy of the application will be emailed to this address.
	Web Site Address:
	Location of Accounting Records:	*

7.	First date sales will be made from this location:	*
7.	Date business first started operations:	*

8.	(For Occupational License purposes only)

	Hotels/Motels/Tourist Courts, etc
8.	For Occupational License purposes:
	Occupational License: View List of Businessess
	Occupational License Fee Charts
		Number of rooms:	×	$1.00	=	$0.00	Tax:
	Amusement Devices						Penalty:
		Number of devices:	×	$10.00	=	$0.00	Interest:
	Video Poker Machines:						Total:
		Number of machines:	×	$50.00	=	$0.00

	For Occupational License:
		Do You Sell Food?:	Yes No *
		If yes, please attach a copy of your Board of Health Permit to operate.
		Do you Sell Gasoline or Motor Fuels?:	Yes No *
		Will Your Business have Video Poker/Amusement Devices?:	Yes No *
		If yes, Who own machines:	*
		Date Business Opened:	*
		Please Check Only One (1) of the Boxes Below: *
		Started New Business-Less Than 30 Days-This Calendar Year.
		Business Opened More Than 30 Days.
		Business Opened During the Previous Calendar Year.
		Business Opened Entire Previous Year.
		Contractor (One Time Contract) use Table 2 (not prorated).

	Business opened on or prior to June 30 of current year		$50.00
	Business opened on or after July 1 of current year		$25.00

A.	Gross Receipts for First 30 Days:	*
B.	Number of Months to Operate this Year:	*
C.	Estimated Taxable Gross:	$0.00	(A) Times (B)

	Enter Gross Income:		*

A.	Gross Receipts:	*
B.	Number of Days in Operation:	*
C.	Average Daily Receipts:	$0.00	(A) Divided by (B)
D.	Estimated Taxable Gross:	$0.00	365 Days Times (C)

	Start Date of Job:		*
	Amount of Contract:		*
	Location of Job-Street Address:
	*

	MAKE CHECKS PAYABLE TO:	PARISH SALES TAX FUND
	MAILING ADDRESS:	TERREBONNE PARISH SALES TAX DEPT. P. O. BOX 670 HOUMA, LA 70361-0670

Please choose a business category that best describes your business activity*

NAIC	Category Description	Detail Description
111000	Agriculture, Forestry, Fishing	Crop Production
112000	Agriculture, Forestry, Fishing	Animal Production
211000	Mining	Oil & Gas Production
212000	Mining	Mining (Except Oil & Gas)
236000	Construction	Construction of Buildings
237000	Construction	Heavy & Civil Engineering Construction
238000	Construction	Specialty Trade Contractors
311000	Manufacturing	Food Manufacturing
312000	Manufacturing	Beverage & Tobacco Product Manufacturing
314000	Manufacturing	Textile Product Mills
322000	Manufacturing	Paper manufacturing
324000	Manufacturing	Petroleum & Coal Products Manufacturing
325000	Manufacturing	Chemical Manufacturing
326000	Manufacturing	Plastics & Rubber Product Manufacturing
339000		Miscellaneous Manufacturing
423000	Wholesale Trade	Merchant Wholesalers, Durable Goods
424000	Wholesale Trade	Merchant Wholesalers, Nondurable Goods
441000	Retail Trade	Motor Vehicle & Parts Dealer
442000	Retail Trade	Furniture & Home Furnishing Stores
443000	Retail Trade	Electronic & Appliance Stores
444000	Retail Trade	Building Material & Garden Equip/Supplies
445000	Retail Trade	Food & Beverage
446000	Retail Trade	Health & Personal Care Stores
447000	Retail Trade	Gasoline Stations
448000	Retail Trade	Clothing & Clothing Accessories Stores
451000	Retail Trade	Sporting Goods, Hobby, Book/Music Stores
453000	Retail Trade	Miscellaneous Store Retailers
454000	Retail Trade	Nonstore Retailers
482000	Transportation & Warehouse	Rail Transportation
484000	Transportation & Warehouse	Truck Transportation
485000	Transportation & Warehouse	Transit & Ground Passenger Transportation
493000	Transportation & Warehouse	Warehousing & Storage
512000	Information	Motion Picture & Sound Recording Industries
515000	Information	Broadcasting (except internet)
517000	Information	Telecommunications, Internet Service Providers
518000	Information	Portals & Data Processing Services
521000	Finance & Insurance	Monetary Authorities
524000	Finance & Insurance	Insurance Carriers & Related Activities
531000	Finance & Insurance	Real Estate
532000	Finance & Insurance	Rental & Leasing Services
541000	Professional, Scientific & Technology	Professional, Scientific & Technology
551000	Management of Companies	Management on Companies & Enterprises
611000	Educational Services	Educational Services
621000	Health Care & Social Assistance	Ambulatory Health Care Services
622000	Health Care & Social Assistance	Hospitals
623000	Health Care & Social Assistance	Nursing & Residential Care Facilities
711000	Arts, Entertainment & Recreation	Performing Arts, Spectator Sports & Related Industries
712000	Arts, Entertainment & Recreation	Museums, Historical Sites, & Similar Institutions
713000	Arts, Entertainment & Recreation	Amusement, Gambling & Recreation Industries
721000	Accommodation & Food Service	Accommodation
722000	Accommodation & Food Service	Food Services & Drinking Places
811000	Other Services	Repair & Maintenance
812000	Other Services	Personal & Laundry Services
813000	Other Services	Religious, Grantmaking, Civic, Professional & Similar Services
815000	Other Services	Miscellaneous Other Services

	Explain: Indicate if parish, school district, or related entity such as hospital or library: Purpose of organization (religious, scientific, humane, fraternal, or other):
9.	Type of Organization:	*
	*

10.	( If Sole Owner (individual) ):

If Sole Owner (individual):
Name (F/MI/L):	*
Last 4 Digits of SSN:	*
Home Address:	*
City:	*	State:	*	Zip:	*
Telephone:	- - *

11.	( If Corporation, LLC, LLP, or Partnership: )

If Corporation, LLC, LLP, or Partnership: name, title, social security number, home adddress, and telephone number of officers, members, managers, or partners:
Name (F/MI/L):	*
Last for digits of SSN:	*
Title:	*
Home Address:	*
City:	*	State:	*	Zip:	*
Telephone:	- - *

Name (F/MI/L):	*
Last four digits of SSN:	*
Title:	*
Home Address:	*
City:	*	State:	*	Zip:	*
Telephone:	- - *

	Describe in detail your business: type of sales, activity, or service you perform:
12.	Nature of Business:	*
	*

14.	Requested Reporting Status:	*
14.	Reporting frequency and filing status will be determined by the Administrator according to parish policy. Businesses with a location within a parish will automatically be registered to file on a monthly basis. Occasional/irregular filers are intended for those businesses (1) that do not have a location within the parish and do not intend on doing business on a regular basis or (2) business that performs services that are not taxable.

15.	Do you desire to have blank reports mailed to your business:	Yes No *

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For Occupational License: